Action Points

A weight-management intervention that emphasized prevention of weight gain, rather than weight loss, achieved the goal in a majority of overweight and obese African-American women, who maintained their weight for 18 months.

Note that the intervention program used in the study had five components: tailored behavior modification goals, weekly self-monitoring by interactive voice response, 12 monthly counseling calls by a registered dietitian, tailored skills training materials, and a 12-month YMCA membership.

A weight-management intervention that emphasized prevention of weight gain, rather than weight loss, achieved the goal in a majority of overweight and obese African-American women, who maintained their weight for 18 months, investigators reported.

After a year of follow-up, patients in the intervention group had a mean weight loss of more than 2 pounds versus continued weight gain in a control group that received usual care. Significantly more patients in the intervention group were at or below their baseline weight than in the control group.

"Weight gain prevention has important health benefits for this population and prevention messages have sociocultural salience," the authors concluded. "Promoting weight loss is a challenge in all populations, but it has been consistently and disproportionately more onerous among black women."

"It is clear that new treatment approaches, such as weight gain prevention, are necessary to contend with the considerable challenge of obesity in this population."

Major trials of weight-loss interventions have consistently demonstrated smaller and clinically less important losses in black women. The consistency of the findings suggests a need for new approaches to weight management for this patient population, the authors noted in their introduction. Weight gain prevention represents one potential alternative strategy.

Weight gain prevention could have significant implications for black women. Studies have shown that overweight and class 1 obesity (body mass index 25 to 34.9) have lesser associations with all-cause and cardiovascular disease (CVD) mortality in black versus white women. Cardiometabolic risk factors also have weaker associations with overweight and class 1 obesity in black women than in white women.

However, prevention of weight gain could prove to be especially challenging in that population, as premenopausal black women average more weight gain per year than do women of other racial/ethnic groups. By age 40 to 59, twice as many black women have class 2 obesity as do white women and three times the prevalence of class 3 obesity.

Prevention of weight gain might be a worthwhile goal in black women because they might be more receptive to intervention messages about weight maintenance, given that black women are more likely than white women to be satisfied with their weight and have less social pressure to lose weight, Bennett and co-authors said.

Prevention of weight gain also offers the advantage of requiring less-intense intervention than does weight loss.

To examine the efficacy of a strategy of weight gain prevention, the authors performed a randomized clinical trial involving overweight and class 1 obese black women 25 to 44, recruited at community health clinics. The patients were randomized to a multimodal intervention known as the Shape Program or to usual care.

According to the authors, Shape was developed specifically as a strategy to prevent weight gain, although modest weight loss may occur as a result of the program. The program has five components: tailored behavior modification goals, weekly self-monitoring by interactive voice response, 12 monthly counseling calls by a registered dietitian, tailored skills training materials, and a 12-month YMCA membership.

The primary outcome was change in weight and BMI at 12 months. Investigators also evaluated maintenance of weight change at 18 months.

The study participants had a mean age of 35, mean baseline weight of 178 pounds, and mean baseline BMI of 30.2. Three-fourths of the participants had annual income <$30,000.

At 12 months, the intervention group had a mean weight versus baseline that was 3.1 pounds lower than that of the control group (95% CI -6.2 to -0.2, P=0.04). Additionally, 62% of the intervention group versus 45% of the usual-care group maintained their weight at or below baseline values (P=0.03). By 18 months, the between-group difference had increased to -3.7 pounds (95% CI -7.3 to -0.4).

The results "provide some much-needed evidence to inform discussions about preventing weight gain in populations at high risk for the health consequences of obesity," said the authors of an accompanying editorial, led by former U.S. Surgeon General Regina Benjamin, MD.

The outcome demonstrates that "a moderate-intensity intervention can prevent weight gain among a high-risk population," continued Benjamin and co-authors Susan Z. Yanovski, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and Denise G. Simons-Morton, MD, PhD, of the National Heart, Lung and Blood Institute.

"Although clinical interventions are important to prevent weight gain in adults and reduce weight in obese adults, we also need effective strategies throughout the lifespan to prevent obesity and its comorbid conditions, as seen at baseline by Bennett et al.," they added. "Clinical approaches targeted to high-risk patients and public health approaches aimed at reducing risk in the population are important."

The study was supported by the National Institute for Diabetes and Digestive and Kidney Diseases.

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